Tandem Autologous-Autologous versus Autologous-Allogeneic Hematopoietic Stem Cell Transplantation for Patients with Multiple Myeloma: Long-term Follow-Up Results from the Blood and Marrow Transplant Clinical Trials Network (BMT CTN) 0102 Trial. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation Giralt, S., Costa, L. J., Maloney, D., Krishnan, A., Fei, M., Antin, J. H., Brunstein, C., Geller, N., Goodman, S., Hari, P., Logan, B., Lowsky, R., Qazilbash, M. H., Sahebi, F., Somlo, G., Rowley, S., Vogl, D. T., Vesole, D. H., Pasquini, M., Stadtmauer, E. 2019


Allogeneic hematopoietic cell transplantation (HCT) may improve long-term multiple myeloma (MM) control through graft vs myeloma (GVM) effect. The BMT CTN 0102 was a biological assignment trial comparing tandem autologous transplant (auto-auto) vs. autologous followed by reduced intensity allogeneic (auto-allo) transplantation in patients with newly diagnosed MM with standard (N=625) or high-risk (beta 2 microglobulin at diagnosis = 4 mg/dl or deletion of chromosome 13 by conventional karyotyping) disease (N=85). While the initial 3-year analysis showed no difference in progression-free survival (PFS) between arms in either risk group, we hypothesized that long-term follow-up may better capture the impact of GVM. Median follow-up of survivors is over 10 years. Among standard risk patients there was no difference in PFS (HR 1.11, 95% C.I. 0.93- 1.35, P=0.25) or OS (HR 1.03, 95% C.I. 0.82-1.28, P=0.82). The 6-year PFS was 25% in the auto-auto vs. 22% in auto-allo arm(P=0.32), and 6-year overall survival (OS) was 60% and 59% respectively (P=0.85). In the high-risk group, while there was no statistically significant difference in PFS (HR 0.66, 95% C.I. 0.41-1.07, P=0.07) and OS (HR 1.01, 95% C.I. 0.60-1.71, P=0.96), a reduction in 6-year risk of relapse, 77% vs. 47% (P= 0.005), was reflected in better PFS, 13% vs. 31% (P=0.05), but similar OS, 47% vs. 51% (P=0.69). Allogeneic HCT can lead to long-term disease control in patients with high risk MM and needs to be explored in the context of modern therapy.

View details for DOI 10.1016/j.bbmt.2019.11.018

View details for PubMedID 31756536